The DSM-IV reflects increased attention to the importance of cultural diversity in psychiatric diagnosis and states that cross-cultural diagnosis can be "especially challenging". However, the cultural considerations in the DSM-IV are not explicit guidelines and there is no consensus in the research literature nor in clinical practice on how culture needs to be considered in providing accurate diagnostic services. Research shows that ethnic and language matching between Hispanic patient and clinician affects ratings of symptom severity and diagnostic sensitivity/specificity among adults with schizophrenia, major depression and anxiety disorders. However,the processes by which language and cultural factors influence diagnostic outcomes and factors leading to misdiagnosis have not been systematically investigated. This REP targets severely mentally ill Hispanic, African American and White adults, focusing on the development of a comprehensive process analysis scheme from videotapes of routine diagnostic interviews. Given the increasing gap between minority service needs and the availability of minority service providers, there is a pressing need to train non- minority clinicians in culturally sensitive diagnosis. Therefore, another objective of this REP is to distinguish cultural factors leading to correct and incorrect diagnostic decisions for the development of training videotapes. In the current climate of managed care, the study will compare diagnostic process and outcomes among psychiatric social workers, psychiatrists, and psychologists, all of whom play key roles in psychiatric intake assessment in community health settings. Given the high drop-out rate among ethnic minorities after their first contact with mental health services, this study will also investigate factors predictive of treatment continuity.